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Pelvic Health Rehabilitation: Open Access to the Evidence

A guide created for participants of the Pelvic Health Solutions 3rd Pelvic Health Symposium held at Sunnybrook Hospital in Toronto, Canada on May 1, 2016.

Rehabilitation Tools & Products Home Training Devices

There are many products and devices that are used in pelvic health rehabilitation.  We have compiled a list of devices below.  This list is by no means complete and we welcome your suggestions for items to add.  Disclaimer: The authors do not receive any financial incentives from any device manufacturer or distributor.

Bladder Diaries

Bladder diaries have been recommended as a reliable and valid means of tracking frequency, urgency and episodes of incontinence.  Bladder diaries are often recorded over 7 consecutive days or 3 representative days.   Recently bladder diary Apps have emerged.



Incontinence Skin Care

Urinary and fecal incontinence can contribute to skin irritation and breakdown.  Tena has developed a line of skin care products that are particularly effective in this area.


Pelvic Floor Muscle Training

There is excellent evidence to support pelvic floor muscle training as a means of treating both stress and urge urinary incontinence in women and men.  Although training alone is effective, it is possible that in some siturations, training may be enhanced through the use of devices such as EMG biofeedback, force/pressure biofeedback, or neuromuscular electrical stimulation.  This may be the case particularly in women who have difficulty performing a pelvic floor muscle contraction on assessment, yet to our knowledge, this hypothesis has not been adequately tested.

Electromyography Biofeedback

There are many different types of intravaginal probes that are used to provide EMG biofeedback.  Most have serious design flaws, yet likely give a reasonable global impression of muscle activation. We recentily published a review on this topic:

Keshwani N, McLean L. State of the art review: Intravaginal probes for recording electromyography from the pelvic floor muscles: Intravaginal Probes for Recording Electromyography. Neurourology and Urodynamics. 2015;34:104-112.

For a thorough discussion of EMG and the overactive pelvic floor, see our recently published book chapter:

Gentilcore-Saulnier, E.  Auchincloss, C. & McLean, L. (2016). Electromyography. In Padoa, A., &  Rosenbaum, T.Y (Eds).  The overactive pelvic floor (pp. 175-203). Dordrecht, Netherlands: Springer.  DOI 10.1007/978-3-319-22150-2.

Despite device limitations, there is some evidence of effectiveness of EMG biofeedback to enhance pelvic floor muscle training:

Herderschee R., Hay-Smith EJ, Herbison GP, Roovers JP, Heineman MJ..Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women. Cochrane Database of Systematic Reviews, 2011 Jul 6;(7):CD009252.

Koh, CE, Young, CJ, Young, JM, Solomon, MJ. Systematic review of randomized controlled trials of the effectiveness of biofeedback for pelvic floor dysfunction. British Journal of Surgery, 2008, 95(9), 1079-1087.

Richmond, CF., Martin, DK., Yip, SO, Dick, M.A, Erekson, E.A. Effect of supervised pelvic floor biofeedback and electrical stimulation in women with mixed and stress urinary incontinence. Female Pelvic Medicine & Reconstructive Surgery, April 6 2016 (epub ahead of print).

EMG biofeedback products:

Force/Pressure Biofeedback

Unitl recently, pressure biofeedback was the only alternative to EMG biofeedback. Intravaginal or intra-anal air-filled probes, such as the Peritron, have been used to determine vaginal resting pressure and increases in pressure derived through pelvic floor muscle contraction.  Such mearuements can be deceiving, however, as they will record an increase in pressure in response to increases in intra-abdominal pressure.  Individuals who bear down instead of contracting the pelvic floor muscles properly may interpret, through pressure biofeedback, that they are contracting correctly. As such, problematic motor patterns may be reinforced.  Despite this, the Peritron has been used in some reserach studies (see Peritron PubMed citations)

Recently there has been a surge in development of new force-sensing technologies to provide force biofeedback during pelvic floor muscle training.  There is no research evidence currently available to support any of these devices, but that is likely due to their relative newness in the marketplace.  These devices are compact and wireless, using Bluetooth technology to link into Smartphone Apps, and may be a good solution to motivate women who are comfortable with the technology.


Vaginal Cones

Vaginal cones have been used as a means of enhancing and progressing pelvic floor muscle strength exercises.  There is limited evidence of effectiveness of vaginal cones over pelvic floor muscle training without vaginal cones.



Pessaries are an effective means of enhancing pelvic organ support and continence control in women.  Many pelvic health physiotherapists have completed training on the fitting of pessaries. 

In 2013 the Society of Obstetricians & Gynaecologists of Canada published evidence-based guidelines on the use and fitting of pessaries that is a useful resource: Technical Update on Pessary Use.